AACN’s Healthy Work Environments Initiative

1. AACN’s Healthy Work Environments Initiative

2. The mistakes are all there,waiting to be made. Chess master Savielly Tartakower (1887-1956)

3. Organizations learn and evolvethrough conscious, deliberateaction. Deliberate action is ethical.When the time to act has come,it is unethical not to do something. David Thomas Ethicist, Author of Ethics of Choice

4. Assertion #1 • There is a direct link between work environment and patient safety • Therefore, if we are not addressing our work environment, we are notaddressing patient safety

5. Assertion #2 • Healthy work environments do not just happen • Therefore, if we do not havea formal program in place addressing work environment issues, little will change

6. Assertion #3 • Creating healthy work environments requires changing long-standing cultures, traditions and hierarchies • Therefore, though everyone must be involved in the creation of healthy work environments, the onus is on organizational, departmental and unit leaders to ensure that it happens

7. The Assertions • HWEs are directly linked to patient safety • HWEs require a formal program • Leaders must drive HWEs

8. Healthy WorkEnvironments Require: • Skilled communication • True collaboration • Effective decision making • Appropriate staffing • Meaningful recognition • Authentic leadership

9. AACN Standards for Establishing and Sustaining Healthy Work Environments Skilled Communication Nurses must be as proficient in communication skills as they are in clinical skills

10. AACN Standards for Establishing and Sustaining Healthy Work Environments True Collaboration Nurses must be relentlessin pursuing and fostering collaboration

11. AACN Standards for Establishing and Sustaining Healthy Work Environments Effective Decision Making Nurses must be valued and committed partners in making policy, directing and evaluating clinical care and leading organizational operations

12. AACN Standards for Establishing and Sustaining Healthy Work Environments Appropriate Staffing Staffing must ensure the effective match between patient needs and nurse competencies

13. AACN Standards for Establishing and Sustaining Healthy Work Environments Meaningful Recognition Nurses must be recognized and must recognize others for the value each brings to the work of the organization

14. AACN Standards for Establishing and Sustaining Healthy Work Environments Authentic Leadership Nurse leaders must fully embrace the imperative of a healthy work environment, authentically live it and engage others in its achievement

15. Creating the “case” for a healthy work environment… What do we know? Communication Issues are present in 65% of ALL sentinel events reported to JCAHO

16. Creating the “case” for a healthy work environment… What do we know? Communication Issues • Are present in more than 75% of wrong site surgeries and delays in treatment • Are present in more than 60% of medication errors and ventilator “events”

17. Creating the “case” for a healthy work environment… What do we know? Collaboration Issues • 65% of nurses report personally experiencing verbal abuse in the last year – from other nurses, physicians, patients and patients’ family members1 • 52% of nurses report that abuse or disrespectful behavior is “often” or “frequently” tolerated1 • 77% of hospital caregivers work with colleagues who are condescending, rude or verbally abusive2 1Ulrich B, Lavandero R, Hart K, Woods D, Leggett J, Taylor D. Critical Care Nurses’ Work Environment:A Baseline Status Report. Critical Care Nurse, 2006; 26(5): 46-57 2Maxfield D, Grenny J, McMillan R, Patterson K, Switzler A. Silence Kills, Accessible at www.silencekills.com

18. Creating the “case” for a healthy work environment… What do we know? Collaboration Issues Some docs can make incorrect orders.We let it slide – especially if it is a jerk…For example, one physician prescribed adrug that you should give 3 times a day,but he said to give it twice a day. I let it go,because it was just a pain pill. It wasn’tgoing to make the child any sicker. Quote from a pharmacist inSilence Kills - Seven Crucial Conversations for Healthcare – VitalSmarts, 2005

19. Creating the “case” for a healthy work environment… What do we know? Staffing and Outcomes A Sampling of the Literature • Creating Healthy Work Environments: Appropriate Staffing(CHEST Physician, April 2007) • Impact of the Nurse Shortage on Hospital Patient Care: Comparative Perspectives (Health Affairs, March 2007) • Nurse Staffing in Hospitals: Is There a Business Case for Quality?(Health Affairs, January 2006) • The Working Hours of Hospital Staff Nurses and Patient Safety(Health Affairs, July 2004) • Nursing Burnout and Patient Safety(Journal of the American Medical Association, February 2003) • Hospital Staffing, Organization, and Quality of Care: Cross-National Findings (American Journal of Public Health, July 2002) • Nurse-Staffing Levels and the Quality of Care in Hospitals(New England Journal of Medicine, May 2002)

20. Creating the “case” for a healthy work environment… What do we know? Decision Making An emergency department task force develops a patient report form that can be faxed to inpatient units to facilitate patient transfers and ease overcrowding.The new form is first used for an unstable patient. When faxed to the ICU, no one sees the form. When the patient arrives, no one is available to admitthe patient. Tensions run high, family is angry, everyone “pitches in” to cover… AACN Standards for Establishing and Sustaining Healthy Work Environments – 2005

21. Creating the “case” for a healthy work environment… What do we know? Leadership One of the most decisive functions of leadership is the creation, management,and when necessary, the destruction and rebuilding of culture. Edgar Schein

22. Creating the “case” for a healthy work environment… Are There Challenges? Challenges to the Case forHealthy Work Environments • Link to patient safety not universally recognized • Relationship issues seen as “soft” • Hierarchy and power structures • Difficult to measure improvements • Tradition • Not a “sexy” issue

23. Creating the “case” for a healthy work environment… Are There Challenges? In the $1.5 trillion U.S. Healthcare System… Hospitals, like any other business, need to be accountable for providing services that don’t harm the people they serve. R. Gibson & J. Singh, 2003 Wall of Silence We spend $25,000 for pills, procedures and bedpans for every one dollar on patient safety. R. Wachter & K. Shojania, 2004 InternalBleeding

24. Healthy Work Environments AreEssential for Making Patients Safe This is being demanded by: • The public • Policy makers • Regulators • Healthcare professionals • Common sense and doing the right thing

25. “Painting a picture” of a healthy work environment… Common Threads • Organizational responsibilities • Individual responsibilities • Support for and access to educational programs related to each • Leadership/administration support

26. “Painting a picture” of a healthy work environment… Skilled Communication • Focus on finding solutions • Protect and advance relationships • Invite and hear all perspectives • Goodwill and mutual respect • Congruence between action and words • Zero-tolerance policies • Formal structures for communication • Access to technology • Evaluation component • Part of performance appraisal

27. “Painting a picture” of a healthy work environment… True Collaboration • Accountability defined • Decision-making authority • Access to resources for dispute resolution • All embrace “culture” of collaboration • Respect each voice • Personal integrity • Skilled communication • Competence of all team members • Nurse managers and MDs equal partners

28. “Painting a picture” of a healthy work environment… Effective Decision Making • Organizational values clear and part of decisionmaking • Structures ensure patients and families are heard • Shared accountability for decision making • Respect for rights of all • All key perspectives incorporated • Processes in place to evaluate results of decisions

29. “Painting a picture” of a healthy work environment… Appropriate Staffing • Staffing policies solidly grounded • Nurses at all levels participate in entire staffing process • Staffing decisions are evaluated • System in place to facilitate access to staffing data • Support services available to ensure nurses focus onnursing work • Technologies adopted that enhance effectiveness of nursing care delivery

30. “Painting a picture” of a healthy work environment… Meaningful Recognition • Comprehensive recognition program in place for all • Systematic process for knowing how to participate • Bedside to boardroom • Includes process to determine that recognition is meaningful • Recognition system is regularly evaluated • Everyone is responsible

31. “Painting a picture” of a healthy work environment… Authentic Leadership • Understand requirements/dynamics at point of care • Generate visible enthusiasm • Role model communication, collaboration, etc. • Evaluate leaders’ impact and progress toward HWE • Ensure leaders are well positioned and supported • Provide time, financial and human resources • Provide co-mentoring • Include leader’s role in HWE in performance appraisal

32. Call to Action • Nurses and all health professionalsEmbrace, develop, follow through • Healthcare organizationsAdopt, implement, evaluate, role model • AACN and the community of nursingPromote, develop, publicize

33. Our lives begin to end the day we become silent about things that matter.Martin Luther King Jr.

34. AACN Standards for Establishing and SustainingHealthy Work Environments:A Journey to Excellence www.aacn.org/hwe